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Prostate Cancer – Matepukupuku
Repeure
Understanding Cancer – A guide for men with prostate cancer.
Cancer Society of New Zealand – Te Kāhui Matepukupuku o Aotearoa
Adapted in accordance with Section 69 of the Copyright Act 1994 by the
Royal New Zealand Foundation of the Blind, for the sole use of persons who
have a print disability.
Produced 2013 by Accessible Format Production, RNZFB, Auckland
This edition is a transcription of the following print edition:
Published by the Cancer Society
PO Box 12700, Wellington 6011
Copyright 2013 Cancer Society of New Zealand Inc.
ISBN: 0-908933-95-9
Publications Statement
The Cancer Society’s aim is to provide easy-to-understand and accurate
information on cancer and its treatments and the support available. Our
cancer information booklets are reviewed every four years by cancer doctors,
specialist nurses and other relevant health professionals to ensure the
medical information is reliable, evidence-based and up-to-date. The booklets
are also reviewed by consumers to ensure they meet the needs of people with
cancer.
This edition of Prostate Cancer/Matepukupuku Repeure includes new
features in response to suggestions from those who review our booklets, and
to meet the needs of our readers.
Our key messages and important sections have been translated into te Reo
Māori.
Our translations have been provided by Hohepa MacDougall of Wharetuna
Ma-ori Consultancy Services and have been peer reviewed by his colleagues.
Other titles from the Cancer Society of New Zealand/Te Kāhui
Matepukupuku o Aotearoa
Booklets
Advanced Cancer/Matepukupuku Maukaha
Bowel Cancer/Matepukupuku Puku Hamuti
Bowel Cancer and Bowel Function: Practical advice
Breast Cancer/Te Matepukupuku o nga Ū
Breast Cancer in Men: From one man to another
Cancer Clinical Trials
Cancer in the Family: Talking to your children
Chemotherapy/Hahau
Complementary and Alternative Medicine
Eating Well during Cancer Treatment/Kia Pai te Kai i te wā Maimoatanga
Matepukupuku
Emotions and Cancer
Got Water?/He Wai?
Kanesa o le susu/Breast Cancer (Samoan)
Lung Cancer/Matepukupuku Pūkahukahu
Melanoma/Tonapuku
Radiation Treatment/Haumanu Iraruke
Secondary Breast Cancer/Matepukupuku Tuarua ā-Ū
Sexuality and Cancer/Hōkakatanga me te Matepukupuku
Understanding Grief/Te Mate Pāmamae
Brochures
Being Active When You Have Cancer
Being Breast Aware
Bowel Cancer Awareness
Gynaecological Cancers
Questions You May Wish To Ask
Talking to a Friend with Cancer
Thermography
Page 1
Introduction
This booklet has been prepared to help you understand more about prostate
cancer – a cancer of the prostate gland. The prostate gland is found only in
men.
The booklet provides information about diagnosis and treatment.
We suggest you also read our booklet Coping with Cancer: Your guide
to support and practical help.
We hope this information will answer some of the questions you may have.
We cannot tell you the best way of managing or treating your prostate cancer.
You need to discuss this with your own doctors.
The words in bold in the text are explained in the glossary at the end of this
booklet.
Pages 2-3
Contents
Introduction – page 1
What is cancer? – page 4
Key messages – page 8
The prostate – page 10
Prostate cancer – page 12
How common is prostate cancer? – page 13
Causes of prostate cancer – page 14
Prostate symptoms – page 15
Diagnosing prostate cancer – page 17
Digital rectal examination (DRE) – page 17
A blood test for prostate-specific antigen – page (PSA) 17
Ultrasound examination and biopsy – page 19
Grading – page 20
Other tests – page 23
Bone scan – page 23
X-rays – page 23
CT scan – page 23
MRI – page 24
Staging the cancer – page 25
TNM staging of prostate cancer – page 26
Managing and treating your prostate cancer – page 30
Active surveillance – page 32
Surgery – page 33

Advantages of radical prostatectomy – page 34

Side effects of radical prostatectomy – page 34
Radiation treatment – page 36

Advantages of radiation treatment – page 37
External beam radiation – page 38

Side effects of radiation treatment (external beam) – page 40
Page 3
Low-dose rate brachytherapy – page 42

Side effects of brachytherapy – page 42
High-dose rate brachytherapy – page 46
Hormone treatment – page 46

Luteinising hormone-releasing hormones therapy – page 46

Anti-androgen therapy – page 47

Orchidectomy – page 47

Side effects of hormone treatment – page 48
Combined treatment – page 50
New treatments – page 51
Chemotherapy – page 51
Immunotherapy – page 52
Treatment for advanced prostate cancer – page 53
Clinical trials – page 54
Complementary and alternative therapies – page 55
Traditional healing – page 56
Making decisions about treatment – page 57
Managing side effects of prostate cancer treatments – page 59
Improving continence – page 59
Sex and prostate cancer – page 60
Bowel function after treatment for prostate cancer – page 64
Nutrition and diet – page 65
Exercise – page 66
Depression – page 67
Cancer Society information and support services – page 70
Suggested websites – page 71
Glossary – page 72
Questions you may wish to ask – page 76
Notes – page 78
Feedback – page 83
Page 4
What is cancer?
Cancer is a disease of the body’s cells. It starts in our genes. Our bodies are
constantly making new cells: to enable us to grow, to replace worn-out cells or
to heal damaged cells after an injury. All cancers are caused by damage to
some genes.
This damage usually happens during our lifetime, although a small number of
people inherit a damaged gene from a parent when they are born. Normally,
cells grow and multiply in an orderly way. However, damaged genes can
cause them to change. They may grow into a lump which is called a tumour.
The beginnings of cancer
Diagram:
Title: The beginnings of cancer
Transcriber's Note: The diagram shows 4 stages to cancer.
The first stage shows a row of light coloured "Normal Cells".
Beneath these cells is a black line called "Basement Membrane".
Beneath the Basement Membrane is a "Lymph Vessel"
Beneath the Lymph Vessel is shown a "Blood Vessel"
The second diagram is the same except for a few of the normal
cells at the top have changed to a dark colour and are labelled
"Abnormal Cells".
The third stage shows these abnormal cells multiplying upwards
and outwards. These dark cells are labelled "Abnormal cells
multiply (Cancer in situ)"
The fourth and final stage shows a large cluster of these dark cells,
which now have a direct line into the blood vessel. This large group
of cells is labelled "Malignant or invasive cancer".
End of Note.
End of Diagram.
Tumours can be benign (not cancerous) or malignant (cancerous). Benign
tumours do not spread to other parts of the body.
Page 5
How cancer spreads
Diagram:
Title: How Cancer Spreads
Transcriber's Note: The diagram shows a cross section of skin
and how cancer grows.
There are 7 labels on the cross section. The first, starting from the
top and working down is:
"Primary Cancer" – This shows a raised dark area on top of the
skin cells.
The second is "Local Invasion" – This shows very dark cells
beneath the primary cancer. It is spreading through the lymph and
blood vessels.
The third is "Basement membrane" – This shows a thin dark area
beneath the normal cells.
The fourth is "Lymph Vessel" – This shows a lymph vessel within
the skin which has been enveloped partially by the local invasion.
There are dark black cell spots within this lymph vessel.
The fifth is "Metastasis" – This shows dark cells in the skin and
blood and lymph vessels.
The sixth is "Cells move away from primary tumour and invade
other parts of the body via bloody vessels and lymph vessels".
The seventh is "Bloody vessels" – This shows the blood vessel
leading up to the tumour. There are dark cancer cells within the
blood vessel.
End of Note
End of Diagram.
A malignant tumour is made up of cancer cells. When it first develops, a
malignant tumour may be confined to its original site. If these cells are not
treated they may spread beyond their normal boundaries and into surrounding
tissues which is called invasive cancer.
Sometimes, cells move away from the original (primary) cancer through the
blood or lymphatic systems and invade other organs. When these cells
reach a new site they may form another tumour. This is called a secondary
cancer or metastasis. For example, if prostate cancer spreads to the bone, it
is called a bone secondary (or metastasis).
Pages 6 - 7
Your cancer doctor will still refer to it as prostate cancer even though it has
spread to another part of your body.
The sort of treatment you are offered for cancer depends on the type of
cancer, where it began and whether it has spread.
Your cancer doctor will also take into account other things about you, such as
your age and general health.
Treatment for cancer includes surgery, radiation treatment, hormone
treatment or chemotherapy (drug treatment).
Immune therapy or targeted treatments, which are now used to treat some
cancers, will become increasingly important in the future.
Sometimes only one of these methods of treatment is used for a cancer.
Sometimes more than one is used.
He aha te matepukupuku?
He mate te matepukupuku ka pa ki ngā pūtau o te tinana.
Ka tīmata ki roto i ō tātou ira. E kore e mutu te mahi a te tinana ki te hanga
pūtau hou; kia tipu ai tātou, hei whakahou i ngā pūtau kua ruha, ki te
whakaora hoki i ngā pūtau kua hē i ngā wharanga kino noa. Ka puta katoa
ngā matepukupuku nā runga i ngā tukinotanga ki ētahi momo ira.
Ka pā ēnei tūkinotanga huri noa i te wā o tō tātou oranga, heoi, arā ētahi
tāngata torutoru nei, heke tuku iho ai tētahi ira kua tūkinotia mai i tētahi o ō
rātou mātua ka whānau ana.
Page 8
Box:
Key messages
The prostate
The prostate is a small gland, normally about the size of a ping pong ball. It
sits just below the bladder and surrounds the upper part of the urethra – the
tube that carries urine from the bladder and semen from the testicles to the
outside of the body through the penis.
Early prostate cancer causes no symptoms.
A biopsy of the prostate is the only way cancer can be diagnosed.
If your biopsy sample contains cancer it is graded to show how active the
cancer is.
The results of the tests are used to work out the stage of your cancer – how
large it is and whether it has spread.
Treatments for prostate cancer

active surveillance

surgery

radiation treatment

hormone therapy.
If the cancer has not spread beyond the prostate, the whole gland can be
surgically removed.
Page 9
Radiation treatment is the use of high-energy radiation to destroy cancer cells
or prevent them from reproducing.
There are three types of radiation treatment for prostate cancer:

external beam

low-dose rate brachytherapy

high-dose rate brachytherapy.
Prostate cancer needs the male hormone testosterone to grow. There are a
number of different ways to slow down or shrink the cancer by reducing the
body’s testosterone levels.
End of Box
Page 10
The prostate
The prostate is a small gland, normally about the size of a ping pong ball. It
sits just below the bladder and surrounds the upper part of the urethra – the
tube that carries urine from the bladder and semen from the testicles to the
outside of the body through the penis.
Diagram:
Title: The male reproductive system
Transcriber's Note: The diagram shows a cross section of the
male reproductive system.
There are 10 areas labelled on the diagram. Working in a
closewise direction these areas are:
'Scrotum' – the pouch which contains the testicle.
'Testicle' – concealed inside the Scrotum.
'Penis' – sits above the Scrotum.
'Urethra' – the tube inside the penis from which Urine and Semen
flow through.
'Prostate gland' – Sits internally behind the penis close to the
bladder and Seminal visicle.
'Bladder' – Sits internally above the penis.
'Seminal visicle' – A small pouch below the bladder and just above
the prostate gland.
'Rectum' – towards the back of the body, between the spine and
the bladder.
'Vas deferens' – the tube which links the testicle with the Urethra.
'Spine' – shown running down the back of the male body.
End of Note.
End of Diagram
Page 11
The prostate produces most of the fluid that makes up semen. The growth
and development of the prostate depends on the male sex hormone,
testosterone, which is produced by the testicles. It is common for the prostate
gland to get larger as men grow older.
This increase in size is called benign prostatic hyperplasia (BPH). BPH is
the usual cause of the urinary symptoms that older men complain about.
Prostate cancer is only occasionally responsible for these symptoms.
Te repe tātea
He repe pakupaku te repe tātea, ka āhua pērā te rahi ki te pōro poikōpiko. Ka
noho ki raro iho i te tōngāmimi me tana pōkai i te wāhanga whakarunga o te
taiawa mimi – te ngongo kawe i te mimi mai i te tōngāmimi me te tātea mai i
ngā raho ki waho o te tinana mā te ure.
Page 12
Prostate cancer
Early prostate cancers are contained within the prostate gland and are called
localised cancers.
Spread of the cancer through the capsule (the outer covering) of the prostate
is known as extracapsular spread or locally advanced cancer.
Some prostate cancers spread to other parts of the body, such as the bones
and lymph glands. This is called metastatic, secondary or advanced cancer.
Cancer cells can move through the lymphatic system or blood stream.
Matepukupuku repe tātea
Noho ai ngā matepukupuku repeure ka puta moata, ki roto i te repeure, kīia ai
he matepukupuku ka noho ki taua wāhi.
Ka hōrapa ana te matepukupuku mā te capsule (te ūhi whakawaho) o te repe
tātea ka kīia tērā he hōrapa extracapsular, he matepukupuku maukaha noho
ki taua wāhi.
Ka hōrapa ētahi matepukupuku repeure ki wāhi kē o te tinana, pērā ki ngā
kōiwi, ki ngā repe waitinana hoki. Kīia ai tēnei he metastatic, he
matepukupuku tuarua, maukaha rānei.
Page 13
How common is prostate cancer?
Prostate cancer occurs most commonly in men aged over 50 years and is the
most common cancer among New Zealand men. Around 3,000 men are
diagnosed with prostate cancer in New Zealand each year.
Pēhea te whānui o te pā o te matepukupuku
repeure?
Ka puta te whānui te matepukupuku repeure ki ngā tāne e 50 tau te pakeke,
neke atu rānei, ā, koia te matepukupuku kitea noatia ana i te nuinga o te wā,
ki roto i ngā tāne o Aotearoa. Āhua 3,000 ngā tāne ki Aotearoa i ia tau, ia tau,
e whakatauria ana kua pāngia ki te matepukupuku repeure.
Box:
"Cancer turned my world upside-down."
Ross
End of Box
Page 14
Causes of prostate cancer
The causes of prostate cancer are not yet fully understood. The chance of
getting prostate cancer increases as you get older. You have a greater
chance of getting prostate cancer if other family members have had it.
Page 15
Prostate symptoms
Men with early prostate cancer are unlikely to have any symptoms, as these
only occur when the cancer is large enough to put pressure on the urethra
(the tube that drains urine from the bladder).
In men over the age of 50, the prostate gland often gets larger due to a noncancerous condition called benign prostatic hyperplasia (BPH) (see page 11).
The symptoms of both benign enlargement of the prostate gland and
malignant tumours (cancer) are similar and can include any of the following:

difficulty passing urine

passing urine more frequently than usual, especially at night

pain when passing urine

blood in the urine (this is not common).
Occassionally, these symptoms may be due to prostate cancer.
If you have any of these symptoms it’s important to get them checked by your
doctor.
Page 16
Ngā tohumate repetatea
Kāore pea e puta he tohumate ki ngā tāne kua pāngia moata ki te
matepukupuku repeure i te mea, ka puta noa iho ngā tohumate i te wā kua
rahi rawa te tipu o te matepukupuku ā, kua pēhi i te awa mimi (te ngongo
kawe i te mimi mai i te tōngāmimi).
Mō ngā tāne e 50 tau te pakeke, neke atu rānei, he nui ngā wā ka āhua rahi
ake te tipu o te repe tātea nā runga i tētahi momo mate kore-matepukupuku e
kīia ana ko te benign prostatic hyperplasia (BPH).
He ōrite ngā tohumate o te whakarahinga mārire o te repe tātea me ngā puku
marere (matepukupuku) me te whai pea i ētahi o ēnei āhuatanga:

uaua te mahi mimi

ka nui ake ngā wā mimi, tae noa ki ngā wā o te pō

ka mamae i ngā wā mimi

ka puta he toto i roto i te mimi (kāore e tino kitea ana tēnei).
I etahi wā, tērā pea nā te matepukupuku repeure i puta ai ēnei tohumate.
Ki te whai koe i ētahi o ēnei tohumate, he mea nui kia tirohia koe e tō rata.
Page 17
Diagnosing prostate cancer
You may have some or all of the following tests.
Digital rectal examination (DRE)
The doctor puts a gloved finger into your rectum (back passage) and feels
the prostate through the rectal wall. If your doctor finds a change in the shape,
size or texture of the prostate, a biopsy may be arranged (see page 19).
A blood test for prostate-specific antigen (PSA)
PSA is a chemical (glycoprotein) produced by the prostate and carried in the
semen and a small amount gets into the blood. PSA levels may rise due to
benign enlargement of the prostate, inflammation or infection of the gland
(prostatitis) and prostate cancer.
A raised PSA test indicates that your risk of having prostate cancer is higher
compared with a person with a normal PSA. A general rule of thumb is that if
you have a PSA higher than four, a biopsy should be considered. In older
men, a small rise in PSA level may be normal.
Some men can have prostate cancer with a normal PSA.
For men with prostate cancer, the PSA level can be used to monitor how
effective treatment has been. If your treatment is active surveillance (see
page 32) your PSA level will be monitored closely.
Page 18
Box:
"It’s hard to think about talking when you are diagnosed. You feel so
overwhelmed with your own feelings that it is hard to share the diagnosis in a
calm and controlled way. Try to allow yourself time to collect your thoughts."
Arama
End of Box
He whakamātau toto mō te repe tāteatauwhaiti
antigen (prostate-specific antigen – PSA)
Tērā pea ka piki ngā taumata PSA nā runga i te whakarahinga mārire o te
repe tātea, te kakā, te mate whakapokenga rānei o te repe (te prostatitis), nā
te matepukupuku repeure.
He tohu te whakamātau PSA kei te nui ake tō noho mōrea ki te putanga o te
matepukupuku repeure ki te whakataurite ki te tangata e whai ana i te PSA
rōnaki.
Page 19
Ultrasound examination and biopsy
A biopsy of the prostate is the only way cancer can be diagnosed. The
information from the biopsy will help you and your cancer doctor make
decisions about management of your prostate cancer.
A biopsy is a small sample of tissue removed from the body. Local
anaesthetic is injected around the prostate and the man is awake through the
procedure.
Most men find their biopsy mildly uncomfortable. A biopsy of the prostate is
done using a needle which is directed into the prostate, either through the wall
of the rectum (this is called transrectal ultrasound or TRUS) or through the
skin of the perineum (the area between the rectum and the scrotum).
Ultrasound is used to guide the needle. After a prostate biopsy, many men
have blood in their urine for a few days. Some men may have blood in their
semen.
Antibiotics are given before and after the biopsy to prevent infection. An antiinflammatory pill may prevent discomfort.
The pathologist will assess the tissue that has been removed to see if there is
any prostate cancer present. If prostate cancer is present, the pathologist will
assess how active the cancer is and how likely it is to spread. This is called
grading.
Whakamātau pāorooro me te unuhanga
Mā te unuhanga o te repeure anake e taea ai te whakatau i te matepukupuku.
Ka āwhina ngā mōhiohio o te unuhanga i a koe me tō rata whakarite
whakataunga mō te whakahaere o te matepukupuku repeure.
Page 20
Grading
If your biopsy sample contains cancer it is graded to show how active the
cancer is. The pathologist looks at the pattern made by the cancer cells and
gives that pattern a grade from 1 to 5. This is called Gleason grading.
The current thinking is that grade 1 is not cancer and grade 2 is very rarely
found. Cancer cells are graded 3 to 5.
The pathologist may see more than one grade of cancer, so the grade of the
two most common patterns in the biopsy samples are added together to give
a Gleason score. For example, if the biopsy shows that most of the cancer is
grade 3 and the second most common pattern seen is grade 4 the Gleason
score will be 3 + 4, and the Gleason score will be 7. The higher the Gleason
score the more active the cancer and the more likely it is to spread.
Pathologists give a Gleason grade of 3 or more for each pattern, so your
Gleason score can be between 6 and 10.
Mahi whakataumata
Mehemea he matepukupuku kei roto i te tauira unuhanga ka whakataumatatia
ki te whakaatu i te kaha mahi a te matepukupuku. Ka tiro te kaimātai
tahumaero ki te hoahoa ka puta nā runga i ngā pūtau matepukupuku, katahi
ka hoatuna he tohu mai i te 1 ki te 5. Ki taua hoahoa. Kīia ai tēnei ko te
whakataumata Gleason.
Page 21
Gleason chart
Note the differences between 3+4 and 4+3, along with 4+5 and 5+4.
Table:
Gleason Score
Description of the two patterns
3+3
All of the cancer cells found in the biopsy are likely to grow
slowly.
3+4
Most of the cancer found in the biopsy looks likely to grow
slowly.
There were some cancer cells that look more likely to grow
at a more moderate rate.
Gleason Score
Description of the two patterns
4+3
Most of the cancer cells found in the biopsy look likely to
grow at a moderate rate.
There were some cancer cells that look likely to grow
slowly.
4+4
All of the cancer cells found in the biopsy look likely to grow
at a moderately quick rate.
4+5
Most of the cancer cells found in the biopsy look likely to
grow at a moderately quick rate.
There were some cancer cells that are likely to grow more
quickly.
5+4
Most of the cancer cells found in the biopsy look likely to
grow quickly.
5+5
All of the cancer cells found in the biopsy look likely to grow
quickly.
End of Table
Reproduced with the kind permission of Prostate Cancer UK 2012
Pages 22 - 23
Other tests
If the cancer seems to be a more active type, other tests will be done to see if
the cancer has spread. These include:
Bone scan
A bone scan may be used to look for any spread of cancer to your bones. A
very small dose of radioactive material is injected into a vein to highlight any
change in the bone, which may be due to cancer (often called a ‘hot spot’).
The injection may make you feel hot and flushed for a minute or two.
A scanning machine is then used to see if the radioactive material collects in
any areas of your bones.
X-rays
X-rays of the chest and bones may be done to find out whether or not the
cancer has spread to these areas.
CT scan
The computerised tomography (CT) scan is a special type of X-ray that
gives a three-dimensional picture of the inside of your body (including any
cancer). It usually takes about 30 to 40 minutes to complete this painless test.
Page 24
MRI
This is a scan using magnetism to build a picture of the organs inside the
body. The MRI machine is a long cylinder (tube) and when scanning is taking
place it is noisy. Some people feel claustrophobic (closed in) when they are
having a scan. If you think this may happen to you, let them know at the time
when you book your appointment so a mild sedative can be given.
Page 25
Staging the cancer
The results of the tests above are used to work out the stage of your cancer –
how large it is and whether it has spread.
A cancer may be:

confined to the prostate – also called localised prostate cancer

locally advanced, which means it has extended beyond the prostate to
nearby areas

metastatic, which means it has spread to other parts of the body.
While the Gleason score tells us what the cancer looks like under the
microscope, the stage of the cancer tells us where the cancer is found.
Te whakawāhanga i te matepukupuku
Ka whakamahia ngā hua o te whakamātau ki te whakarite i te wāhanga o te
matepukupuku-tōna rahi, mēna kua hōpara hoki.
Tērā pea ka pēnei te matepukupuku:

ka noho apiapi ki te repe tātea kīia ai hoki i ētahi wā, he matepukupuku
repeure noho ki taua wāhi

kua maukaha ki taua wāhi, nā reira ko te tikanga kua hōrapa ki tua atu
o te repe tātea ki ngā wāhi noho tata

kua noho metastatic, ko te tikanga kua hōrapa ki wāhi kē o te tinana.
Page 26
TNM staging of prostate cancer
Prostate cancer is staged using the TNM system. This is used all over the
world. It separately assesses the tumour (T), lymph nodes (N) and
secondary cancer metastases (M).
Prostate cancer stages
Table:
Stage
How far the cancer has spread
T1
The tumour cannot be felt by the doctor or detected on
ultrasound.
T2
The doctor can feel the cancer but it does not appear to have
spread beyond the prostate.
T3
The cancer feels as though it has spread outside the
prostate into surrounding tissues.
T4
The cancer has grown into surrounding organs such as the
bladder or the rectum.
End of Table
Reproduced with the kind permission of the Australian Prostate Cancer
Collaboration
Page 27
Diagram:
Title: T1-3 stages of prostate cancer
Transcriber's Note: The diagram shows the T1 through 3 stages
of prostate cancer. Starting at the top of the diagram and working
down the following labels are:
'Bladder' – shows the bladder above the prostate gland.
'Prostate Gland' – about a quarter the size of the bladder, the
prostate gland is shown directly below the bladder.
'T1' – a small black area is shown inside the prostate.
'T2' – another black area is shown, this one 10 times the size of the
first.
'T3' – the third black area is larger again, and has attached itself to
the wall of the prostate. End of Note.
Reproduced with the kind permission of ConcerHelp UK 2012.
End of Diagram:
Pages 28 - 29
Diagram:
Title: T4 stage of prostate cancer
Transcriber's Note: The diagram shows the T4 stage of prostate
cancer. A label points to the cancer called 'T4 tumour invading
other structures'. The other areas indicated which are being
invaded by the cancer are the: 'Bladder', 'Prostate gland', and the
'Rectum'. End of Note
Reproduced with the kind permission of CancerHelp UK 2012
End of Diagram
Page 30
Managing and treating your prostate
cancer
The treatment choices you are offered will be based on all the information the
cancer doctor has about your cancer and what is right for you. This
information will include:

the size of the prostate

the Gleason score

the PSA level

your urinary function

the area where the cancer is located

your general health

your age

your preferred treatment

treatment options available in your area.
Treatments your doctor will consider include:

active surveillance

surgery

radiation treatment

hormone therapy

chemotherapy

immunotherapy (still experimental)

a combination of the treatments listed above.
Page 31
Te whakahaere me te maimoa i tō
matepukupuku repeure
Ka hāngai ngā kōwhiringa maimoatanga ka hoatuna ki a koe, i runga i ngā
mōhiohio katoa kei te pupuri tō rata mō tō matepukupuku me te huarahi e tika
ana mōu Ko ētahi o ngā mōhiohio kei roto ko enei:

te rahi o te repe tātea

te māka Gleason

te taumata o te PSA

te mahi a tō tōngāmimi

te wāhi noho ai te matepukupuku

tō hauora whānui

tō pakeke

te maimoatanga e hiahia ana koe

ngā kōwhiringa maimoatanga e wātea ana i tō rohe.
Kei roto i ngā maimoatanga ka whakaarohia e tō rata ko enei:

tirotiro ngangahau

hāparapara

maimoa iraruke

haumanu taiaki

mahi hahau

immunotherapy (ke te whakamātauria tonu tēnei)

he kowhiringa o ngā maimoatanga kua rāngitia ki runga nei.
Page 32
Active surveillance
Patients with cancers at very low risk or low risk of spreading may be offered
active surveillance. This is a management strategy where the cancer is not
immediately treated but is very closely monitored (regular PSA and repeat
biopsy). It is only treated if it shows evidence of changes in the cancer. This
approach is becoming increasingly used as urologists realise that many lowrisk cancers prove a very low threat to the health of men.
If active surveillance is suggested for you, ask your doctor:

how often you will need to schedule check-up appointments

which tests will be done and at what intervals.
Tirotiro ngangahau
Tērā pea ka hoatuna ko te tirotiro ngangahau ki ngā tūroro whai
matepukupuku e noho paku rawa ana te mōrea ki te hōrapa haere. He rautaki
whakahaerenga tēnei kāore e tere huri ki te maimoa i te matepukupuku,
engari ka ata aroturukihia (he nui te PSA me he unuhanga tārua).
Page 33
Surgery
If the cancer has not spread beyond the prostate, the whole gland can be
surgically removed. This is called radical prostatectomy, and the operation
is done to try to cure the cancer. Surgery is performed through an incision in
the lower abdomen and the entire prostate is removed from the body, with the
bladder being joined back on to the urethra. This operation requires a stay of
a few days in hospital. It would be usual to go home with a urinary catheter
in place for about one week. You should be able to resume normal activities
within six weeks.
For information on starting to have sex again, see the section on "Sex and
prostate cancer" on page 60.
Sometimes radical prostatectomy is done using laparascopic (keyhole)
surgery. The surgeon may use robotic tools during the operation. Recovery is
quicker after keyhole surgery. Robot-assisted surgery is only available in the
private sector.
Hāparapara
Mehemea kāore anō te matepukupuku i hōrapa ki tua atu i te repe tātea, ka
taea te tango i te repe katoa mā te mahi hāparapara.
Page 34
Advantages of radical prostatectomy

The cancer can be completely removed by surgery.

The pathologist can examine the removed prostate gland and pelvic
lymph nodes, which means your cancer doctor can give you an
accurate prognosis (outlook).

The PSA level should be undetectable (not seen in a blood test)
following surgery. If it is found, there may be cancer remaining.

If the PSA increases following surgery, cancer cells may remain in the
pelvis where the prostate was. Radiation treatment can be given to this
area. The aim is to get rid of any remaining cancer cells.

Surgery does not cause long-term bowel complications.
Side effects of radical prostatectomy
It is normal to have urinary incontinence (loss of bladder control) for a short
time after your catheter is removed. This usually improves over time,
particularly if you do regular pelvic floor exercises (see page 59 for Kegel
exercises).
The New Zealand Continence Association’s website (www.continence.org.nz)
has useful information you may like to read titled "Continence and Prostate –
A guide for men undergoing prostate surgery".
Page 35
Some men will have some degree of erectile dysfunction (impotence) after
this surgery. Men who had good sexual function before the operation, are
younger, had a small cancer and have a nerve-sparing operation are less
likely to have problems with erections after surgery. Your ability to have an
erection may take up to two years to recover. This can be improved by the
regular use of erectile rehabilitation therapies. See page 63 for managing
these side effects.
Talk to your surgeon about your chances of having these side effects.
Good and bad points of surgery
Good points

You may be able to remove all of your cancer.

Side effects usually get better with time.
Bad points

Many men will have problems with erections afterwards.

Infertility (not able to father a child).

Moderate rates of incontinence, particularly in the early postoperative
stage. A small number of men will have ongoing incontinence.
Page 36
Radiation treatment
Radiation treatment is the use of high-energy radiation to destroy cancer cells
or prevent them from reproducing. Radiation treatment only affects the part of
the body at which the beam(s) is aimed, so is very localised. This form of
treatment works best when the cancer is confined to the prostate.
Radiation treatment may be used as an alternative or additional treatment to
surgery. Treatment is carefully planned to do as little harm as possible to your
normal body tissue. The length of treatment will depend on the size and type
of the cancer and on your general health.
Radiation treatment may also be used to relieve pain caused by secondary
cancers in the bones, or to shrink obstructions in your lymphatic or urinary
systems.
In New Zealand, radiation treatment is only available in the major cities.
Page 37
Advantages of radiation treatment
Radiation treatment may cure prostate cancer that is localised to the prostate.
It avoids removal of the prostate. Men receiving brachytherapy are able to
return to usual activities soon after the implant (see page 42).
There are three types of radiation treatment for prostate cancer:

external beam (EBRT)

low-dose rate brachytherapy

high-dose rate brachytherapy.
Maimoatanga iraruke
Ko te whakamahi i te iraruke pūngao nui te maimoatanga iraruke hei
whakamate i ngā pūtau matepukupuku, ki te ārai rānei i tō rātou hanga hou.
E toru ngā momo maimoa iraruke mō te matepukupuku repeure:

hihi ā-waho (EBRT)

brachytherapy auau horopeta iti

brachytherapy auau horopeta nui.
Page 38
External beam radiation
External beam radiation is where a radiation beam is focused from a machine
outside the body onto the area affected by cancer. To read more about how
radiation treatment works, ask for a copy of the Society’s booklet Radiation
Treatment, which is available at your local Cancer Society, by contacting the
Cancer Information Helpline 0800 CANCER (226 237) or by viewing the
booklet on the Society’s website (www.cancernz.org.nz).
Treatment is usually given daily, for five days each week, for a period of
seven to eight weeks. The machine is on for only a few minutes. The total
amount of time spent in the treatment room is usually 10 to 20 minutes.
Page 39
Photograph:
Caption: Radiation therapists will position you for your radiation treatment –
lie still and breathe normally. (a), (b): Feet stocks and knee rests for both
immobilisation and comfort.
Transcriber's Note: The image shows a radiation therapist
positioning a patient. The patient lies on his back with his knees
resting in the knee rest, and the stocks sitting ontop of his feet. End
of Note.
End of Photograph
Page 40
Side effects of radiation treatment (external beam)
Some men may experience the following side effects when undergoing
radiation treatment:

tiredness

urinary changes, such as increased frequency and a burning sensation
while urinating (discuss these symptoms with your cancer doctor)

a number of men find they slowly develop problems with erectile
function after they have radiation treatment (50 percent within five
years of treatment)

occasionally, bowel symptoms, such as pain and bleeding from
proctitis (inflammation of the rectum) and diarrhoea. Although these
symptoms usually disappear after the end of treatment, a small number
of men may continue to experience bleeding from the bowel. With
modern radiation techniques, bowel problems are much less common.
Page 41
Good and bad points for external beam radiation
Good points

There is less chance you’ll be impotent, compared with surgery when
the nerves are not able to be spared.

There is less chance you’ll be incontinent of urine.

There is a chance that it will kill any cancer that has spread just outside
your prostate.
Bad points

It takes longer to see a result (PSA drops slowly).

You may get some bowel side effects months or even years after
treatment.

Surgery can’t be done after radiation treatment if some cancer remains.

Infertility (not able to father a child).

You may have to travel a long way for treatment.

Problems with erections.
Page 42
Low-dose rate brachytherapy
Low-dose rate brachytherapy is suitable for low-risk cancers that are confined
to the prostate gland. Radioactive seeds are inserted permanently into the
prostate gland.
Side effects of brachytherapy
Common side effects include:

bladder irritation (needing to go frequently and urgently; for most men
this doesn’t last long)

painful urination for a few days after treatment

bowel problems

problems with erections

poor urine flow and, very occasionally, urinary retention (can’t pee).
Blockages of the urethra can occur due to swelling of the prostate soon after
treatment. This is very uncommon.
In the long term, very occasionally, temporary blockages can occur due to a
narrowing of the urethra.
While the seeds will gradually lose their radioactivity, there is little or no risk to
other people. However, the following suggestions are recommended:

If you are resuming sexual intercourse, use condoms for your first two
to three ejaculations after the seeds have been implanted.
Page 43

Do not sit babies or children on your lap for the first two months after
the implant. You may continue to greet or hug them as usual and they
may stay in the same room as you. Source: Prostate Cancer
Permanent Seed Prostate Brachytherapy: Information for patients.
(2007) Oncura. [email protected].

Pregnant women should not sit close to you for longer than a few
minutes a day in the first two months but it is perfectly safe for them to
be in the same room.

Other adults are not at risk and restrictions on time and activities are
not necessary.
For more information, speak to your cancer doctor.
Low-dose rate brachytherapy is currently only available in the private system
through private hospitals.
Page 44
Image:
Caption: This X-ray shows permanent radioactive seeds used for low-dose
rate brachytherapy in the prostate gland. (a): Multiple strands of seeds evenly
spaced throughout the prostate gland.
End of Image
Page 45
Good and bad points of low-dose rate brachytherapy
Good points

There is a lower chance of problems with erections than with other
treatments.

Treatment involves two visits to hospital, with short recovery time.
Bad points

You may get some side effects months or years after treatment.

You may be infertile (not able to father a child). There is a greater risk
of having bladder problems compared with external beam radiation
treatment (EBRT).

High cost.
Box:
"I can’t believe they put 123 of those little seeds at different strengths at
different locations in something the size of a ping pong ball."
Paul
End of Box
Page 46
High-dose rate brachytherapy

With high-dose rate brachytherapy, needles are placed in the prostate
and radioactive sources can then be temporarily placed into the
prostate down the hollow needles.

High-dose rate brachytherapy is always used after a shortened course
of external beam radiation. It is usually used for higher-risk prostate
cancer.
Hormone treatment
Hormones are substances that occur naturally in the body. They control the
growth and activity of cells and may be used to treat prostate cancer.
Prostate cancer needs the male hormone testosterone to grow. There are a
number of different ways to slow down or shrink the cancer by reducing the
body’s testosterone levels.
Luteinising hormone-blocking therapy
Luteinising hormone-blocking hormones, also called luteinising hormone
releasing hormones (LHRH), lowers the amount of testosterone in the body.
LHRH therapy is usually given as a monthly or three-monthly injection.
Page 47
Anti-androgen therapy
Anti-androgens block the ability of testosterone to stimulate the growth of
prostate cancer. The advantage of this type of therapy is that some men
maintain their erections and sexual drive.
This is normally used when LHRH therapy is becoming less effective (when
the PSA level is rising).
Orchidectomy
Orchidectomy or (orchiectomy [American spelling]) is a procedure where
the testicles are surgically removed through a cut in the scrotum. An
orchidectomy permanently deprives the body of testosterone.
The advantage of orchidectomy is that it is a one-off procedure, but the
disadvantage is that any side effects are permanent. Side effects of
orchidectomy are similar to those of LHRH therapy.
Pages 48 - 49
Side effects of hormone treatment
Hormone treatment for prostate cancer can cause loss of interest in sex,
weight gain, hot flushes, mood changes and a risk of depression.
A possible side effect of long-term anti-androgen therapy is osteoporosis
(weakening of the bone due to the loss of bone density). Men on this therapy
should discuss with their doctors ways to preserve bone density (for example,
getting regular exercise).
Box:
"Through the treatment I lost all my sex drive. It’s a real downer. Luckily I can
talk to my wife about this."
Brent
End of Box
Page 50
Maimoatanga taiaki
He mea puta noa ngā taiaki i roto i te tinana. Ka whakahaere rātou i te tipu me
te mahi a ngā pūtau ā, tērā pea ka taea te whakamahi hei maimoa i te
matepukupuku repeure. Me whai rawa te matepukupuku repeure i te
testosterone taiaki tāne e tipu ai ia. He maha tonu ngā ara hei whakatōmuri i
te tipu haere, hei tīngongo rānei i te matepukupuku mā te whakaiti i ngā
taumata testosterone o te tinana.
Combined treatment
For men with locally advanced or high-risk prostate cancer, it is becoming
more common to give hormone treatment to shrink the cancer before giving
radiation treatment. This is known as neo-adjuvant treatment and may last
around six months.
Hormone treatment may be given after surgery or radiation treatment. This is
known as adjuvant treatment.
Page 51
New treatments
Chemotherapy
Chemotherapy may benefit men with advanced prostate cancer when
hormone therapies are no longer working. Chemotherapy is the use of drugs
that kill cancer cells while doing the least possible harm to normal cells. These
are usually given intravenously (into the bloodstream). The aim of
chemotherapy is to treat cancer-related symptoms and it may help men with
advanced cancer live longer. Common side effects of chemotherapy include
tiredness, hair loss and risk of serious infection. LHRH therapy (see page 46)
should be continued while on chemotherapy.
Chemotherapy is not used in early prostate cancer, although clinical trials are
happening to see if there are any benefits for men with early prostate cancer.
Page 52
Immunotherapy
Cancer immunotherapy is the use of the immune system to reject or kill
cancer cells. The man is given a cancer vaccine which stimulates his own
immune system to recognise and destroy prostate cancer cells. It is possible
that immunotherapy will become an important treatment option in the future.
Box:
"I used numbers. I had 30 days of radiation treatment. I used it like a football
score. It was 1–29 tomorrow, then it was 2–28, 3–27 and as I got over half
way I started to come right."
Chris
End of Box
Page 53
Treatment for advanced prostate cancer
If the cancer has spread, your cancer doctor will discuss treatment for specific
problems caused by your cancer.
These may include:

surgery called transurethral resection of prostate (TURP) which is the
removal of prostate tissue that is pressing on the urethra and causing
an obstruction

radiation treatment to painful areas in the bone

bone strengthening treatments

orchidectomy (see page 47), or other hormone treatments to relieve
symptoms and improve quality of life.
Page 54
Clinical trials
If it is suggested that you take part in a clinical trial, make sure that you fully
understand the trial and what it means for you. For more information, see the
Cancer Clinical Trials booklet, which is available from your local Cancer
Society, by phoning the Cancer Information Helpline 0800 CANCER (226
237) or by reading or downloading the booklet from the Society’s website
(www.cancernz.org.nz).
Page 55
Complementary and alternative
therapies
Often, people with cancer seek out complementary and alternative therapies.
Many people feel it gives them a greater sense of control over their illness,
and that it’s ‘natural’ and low-risk, or they just want to try everything that
seems promising.
Complementary therapies include massage, meditation, acupuncture and
other relaxation methods, which are used alongside medical treatments used
by your cancer doctor. They may help you feel better and cope better with
your cancer treatment.
Alternative therapies include some herbal and dietary therapies, which are
used instead of medical treatment. Most have not been tested scientifically.
Those that have been tested have not worked, or have been harmful,
especially if you:

use them instead of medical treatment

use herbs or other therapies that make your medical treatment less
effective.
Be aware that many unproven therapies are advertised on the internet and
elsewhere without any control or regulation.
Page 56
Traditional healing
Traditional healing includes rongoā, Pacific medicine, Ayurveda and Chinese
medicine.
For more information on complementary and alternative medicine we
recommend you read the following Cancer Society booklet and information
sheet:

Complementary and Alternative Cancer Medicine: For people with
cancer, their family and friends (booklet)

"Complementary and Alternative Medicine" (information sheet).
You can find out about what scientific research has been done into specific
herbs, supplements and other products on:

the Memorial Sloan-Kettering website (http://www.mskcc.org/)

the US National Center for Complementary and Alternative Medicines
(NCCAM) website (http://nccam.nih.gov/)

Quack-watch (www.quackwatch.com).
Before using a complementary or alternative remedy or traditional
healing, it is recommended you discuss it with your cancer doctor.
Page 57
Making decisions about treatment
Sometimes it is difficult to make decisions about treatment. You may feel that
everything is happening so fast that you do not have time to think things
through. However, it is important not to be rushed into a decision – it must be
the right one for you. Talking to your cancer doctors a few times before
making a decision on treatment can help. Ideally, talking to a surgeon
(urologist) and an oncologist is helpful.
If you are unsure about the advice given to you by your cancer doctors you
can ask for a second opinion from another specialist.
It can be helpful to talk to other men who have had to make decisions about
the different prostate cancer treatments. The Cancer Society’s Cancer
Connect Service can arrange this for you. Phone the Cancer Information
Helpline 0800 CANCER (226 237).
Ngā mahi whakatau i te maimoatanga
He tino uaua i ētahi wā ki te whakatau he aha te maimoatanga tika mōu. Tērā
pea ka whakaaro koe kei te tere rawa te haere o ngā mahi, kāre koe e whai
wā ki te āta whakaaro i ngā piki me ngā heke. Heoi anō, he mea nui kia kaua
koe e akiakina ki te hoatu i tō whakataunga – me tika hoki mōu. Mā te kōrero
auau ki ō rata i mua i tō whakataunga maimoatanga e āwhina pea i a koe.
He mea pai te kōrero ki tētahi mātanga (kaimātai roma mimi) tētahi kaimātai
matepukupuku rānei.
Pages 58 - 59
Managing side effects of prostate
cancer treatments
Improving continence
Incontinence refers to the accidental leaking of urine, which often happens
during physical activity. The amount of urine leaking can vary from a small to
a large amount.
Continence problems are usually temporary. They may last for, at least, three
months, and are usually sorted out by six to 12 months. Wearing incontinence
pads will help. These are available from supermarkets.
Drinking plenty of fluids (water is best) each day is recommended to help
bladder function. Limit caffeine, alcohol and fizzy drinks. A small number of
men continue to have significant incontinence on a long-term basis.
Regular Kegel pelvic floor exercises, which involve exercising the muscles of
the pelvic floor, help many men regain bladder control after prostate surgery.
It is advisable to start these exercises before starting treatment as normal
sensations may be confused for several weeks afterwards. Ask your doctor, a
nurse or a physiotherapist for information about pelvic floor exercises.
In some areas there are specialist continence advisory nurses. Rarely, men
may need further surgery to implant an artificial sphincter (shut-off valve) if
incontinence persists or worsens. For more information, refer to the
information sheet titled "Continence and Prostate" on the Society’s website or
go to the New Zealand Continence Association website
(www.continence.org.nz).
Page 60
Sex and prostate cancer
As you get older, it usually gets more difficult to have and maintain an
erection.
Men who have had treatment for prostate cancer can expect to be infertile
and may experience changes in their sexual functioning. These changes can
include:

difficulty having an erection

dry orgasm (no or less semen)

loss of interest in sex.
For some men after prostate treatment, difficulty gaining an erection might not
be a big concern for them or their partner. For others it may be very important.
Men may find it difficult to talk to their partners for fear of failure or rejection,
but these fears are often mistaken. Sexual relationships are built on many
things like love, trust, talking to each other and common experiences.
Following radical prostatectomy and radiation treatment a man will no longer
ejaculate semen so he will have a ‘dry’ orgasm. Some men say this feels
totally normal, while others say the orgasm does not feel as strong, longlasting or pleasurable.
Page 61
Sexual partners need to develop different skills to achieve a non-penetrative
orgasm. It will probably take longer to reach an orgasm, which means there
will be more time to enjoy the mutual pleasures of intimate bodily contact.
Keep in mind that no matter what kind of cancer treatment you have, you will
almost always be able to feel pleasure from touching.
Te whakahaere i ngā pāpātanga ki te
taha o ngā maimoa matepukupuku
repeure
He rangitahi ngā wā mate mimi tata. Tērā pea ka noho mō te 3 mārama, ā, ka
whakatikatika noa i roto i te wā 6 ki te 12 mārama.
Kāore e kore ka matapā ngā tāne kua whai i te maimoatanga mō te
matepukupuku repeure, tērā pea ka kite rātou i ngā rerekētanga ka puta ki te
mahi ai. Anei pea ētahi o aua rerekētanga:

he uaua te whakatora i te ure

maroke noa iho te tātea (kāore he tātea, he iti noa iho rānei)

kua kore noa iho e hiahia ai.
Page 62
There are practical ways to help overcome impotence, including:

physical devices such as vacuum pumps and constriction rings that
can help you to achieve and maintain an erection

oral drugs, such as Avigra, Viagra, Cialis or Levitra which are options
to discuss with your cancer doctor. These drugs cannot be used by
men who take nitrate-based medicine for heart problems

injections given straight into the penis to achieve an erection, which
work on many men

a penile implant – a device that achieves an erection through the use of
a small pump within the scrotum. Whilst effective, this treatment may
be expensive.
Box:
"My doctor really helped me when he said ‘You’re in a new relationship, and
I’m guessing that sex is important to you’."
Ross
End of Box
Page 63
If you find changes in your sex life upsetting, you can discuss this with your
cancer doctors. It may be helpful to have some sexual counselling – ask your
specialist, your GP or your local Cancer Society if there are any sexual
counsellors in your area. There may also be a specialist impotence advisory
service in your area where you can discuss treatment options.
Talking to another man who has had this experience following treatment for
prostate cancer may be helpful. To be put in contact with other men who have
experienced changes in their sexual function, contact the Cancer Society’s
Cancer Connect Service by phoning 0800 CANCER (226 237).
You may find the Cancer Society’s booklet Sexuality and
Cancer/Hokakatanga me te Matepukupuku helpful. You can get a copy
from your local Cancer Society, by phoning the Cancer Information Helpline
0800 CANCER (226 237) or by downloading it from our website
(www.cancernz.org.nz).
Box:
"After being impotent for 18 months, the fitting of a penile implant gave me
back my confidence and brought back the intimacy to my relationship."
Steven
End of Box
Page 64
Bowel function after treatment for prostate
cancer
Some men find they have problems with their bowel and bowel motions
(faeces) after external beam radiation, such as:

loose and more frequent bowel motions (diarrhoea, urgency to go to
the toilet and incontinence)

bleeding from rectum (like haemorrhoids or ‘piles’).
These problems may occur months or years after treatment.
These side effects are caused by radiation irritating the lining of the low part of
your bowel. You may need to take antidiarrhoea medication at times. Some
men experience longterm diarrhoea.
Box:
"Being with people who had gone through something similar to me made me
feel less isolated and alone."
Ryan
End of Box
Page 65
Bleeding from the rectum (bottom) can occur if you become constipated (have
hard bowel motions). Straining to pass a bowel motion can cause the bowel to
bleed. Medication may be necessary to make sure your bowel motions are
soft.
Modern radiation techniques are less likely to cause these side effects. If
diarrhoea and bleeding do occur, this will normally settle in about a year. Talk
to your cancer doctor if you have these problems.
Nutrition and diet
The research at the moment is limited and we are unsure how different foods
affect the growth of prostate cancer. However, by eating healthily you can
take control over your own health and actively do something to improve it. It
will also benefit your overall health and reduce your risk of other medical
problems such as heart disease and diabetes.
There is some evidence that a lower intake of animal fat and higher intake of
fruits and vegetables may lower the chance of developing prostate cancer.
Obesity may be related to an increased risk of prostate cancer.
Men on anti-androgen therapy who are at risk of osteoporosis should try to
include calcium in their diets. Good sources of calcium include:

dairy products

green vegetables

nuts

wholegrain foods, such as bread or rice and cereals.
Page 66
Exercise
Exercise is important for general health. It can help you to maintain a healthy
weight by burning up extra energy which would otherwise be stored by the
body as fat. It is unclear whether exercise can help to slow down the growth of
prostate cancer, but it may help with some of the side effects of treatment. It
can also help you cope with any feelings of anxiety or depression.
Page 67
Depression
Men with prostate cancer are nearly twice as likely to develop depression as
other men. Having prostate cancer can cause worry, stress and sadness both
in men with cancer and their partners. Having prostate cancer can make it
seem like an effort to keep active and connect with family members and
friends. This can lead to isolation and may make it harder to recover from
depression. Some treatments for prostate cancer, such as hormone
treatments, can put men at a greater risk of mood changes, depression and
anxiety.
Page 68
Effects on erectile function and sex drive can be a major source of distress. If
this is a problem for you, counselling can be very helpful. Some men may
need medication. Speak to your GP and contact your local Cancer Society
about counselling services in your area.
Maintaining your Wellbeing: Information on depression and anxiety for
men with prostate cancer and their partners is a useful booklet produced
by beyondblue in association with the Prostate Cancer Foundation of
Australia. Use the web address below to locate and read this booklet online:
http://www.beyondblue.org.au/index.aspx?link_id=7.980&t
mp=FileDownload&fid=1345
Box:
"My wife was a trained nurse but even she found coping with my post-surgery
depression extremely difficult. The nature of the disease meant I was selffocused and spent little or no time considering the emotional needs of loved
ones."
Steve
End of Box
Page 69
Matapōuri
He rua noa atu te kaha ake o te puta o te matapōuri ki te tāne e pāngia ana ki
te matepukupuku repeure, e ai ki ētahi atu o te hunga tāne. Kāore e kore ka
puta te māharahara, te kōhukihuki te pōuritanga rurua ki ngā tāne whai
matepukupuku repeure me ō rātou hoa moe.
Tērā pea he mea tino āwhina i a koe te whai tohutohu i tētahi atu tangata
mehemea he raru tēnei mōu. Tērā pea me whai rongoā kē ētahi tāne. Kōrero
ki tō rata ā-rohe me te whakapā atu ki Te Kāhui Matepukupuku ā-rohe mō
ngā ratonga whai tohutohu kei tō takiwā.
Box:
"Some people will say, ‘Let me know if you need anything’, whereas others
will just come and do things."
Gerald
End of Box
Page 70
Cancer Society information and
support services
The Cancer Information Helpline is a Cancer Society service where you can
talk about your concerns and needs with specially trained nurses on 0800
CANCER (226 237). Your local Cancer Society offers a range of services for
people with cancer and their families.
These services may include:

volunteer support including drivers providing transport to treatment

accommodation while you’re having treatment

support and education groups.
The range of services offered differs in each region so contact your local
centre to find out what is available in your area.
For information on practical support and the emotional impact of
cancer, we suggest you read our booklet Coping with Cancer: Your
guide to support and practical help. You can get a copy from your local
Cancer Society, by phoning the Cancer Information Helpline 0800 CANCER
(226 237) or by downloading it from our website (www.cancernz.org.nz).
Page 71
Suggested websites
This booklet is part of a series called Understanding Cancer, which is
published by the Cancer Society.
These booklets, and booklets from the Living with Cancer series, can be
viewed and downloaded from our website (www.cancernz.org.nz).
The following websites also have information on prostate cancer and support:
Macmillan Cancer Support: www.macmillan.org.uk
Cancer Council Queensland: www.cancerqld.org.au
Australian Prostate Cancer Collaboration: www.prostatehealth.org.au
Prostate Cancer Foundation of New Zealand: www.prostate.org.nz 0800 477
678 or 0800 4 PROSTATE
Prostate Cancer Foundation of Australia: www.prostate.org.au
Prostate Cancer UK: prostatecanceruk.org
New Zealand Continence Association: www.continence.org.nz
Mental Health Foundation of New Zealand: www.mentalhealth.org.nz
The suggested websites are not maintained by the Cancer Society of New
Zealand. We only suggest sites we believe offer credible and responsible
information, but we cannot guarantee that the information on such websites is
correct, up-to-date or evidence-based medical information.
We suggest you discuss any information you find with your cancer care health
professionals.
Page 72
Glossary
adjuvant treatment – a treatment that is done along with the main treatment
or after it.
benign – a tumour that is not malignant, not cancerous and won’t spread to
other parts of the body.
benign prostatic hyperplasia (BPH) – a non-cancerous enlargement of the
prostate gland.
biopsy(ies) – the removal of a small sample of tissue from the body for
examination under a microscope to help in diagnosing a disease.
bladder – hollow organ that stores urine.
brachytherapy – a form of radiation treatment where the radiation source is
placed into the area of the body being treated.
cells – the ‘building blocks’ of the body. A human is made of millions of cells,
which are adapted for different functions. Cells are able to reproduce
themselves exactly, unless they are abnormal or damaged, as are cancer
cells.
computerised tomography (CT) scan – a technique for constructing
pictures from cross sections of the body, by X-raying the part of the body to
be examined from many different angles.
differentiation – a medical term used to describe how closely cancer cells
resemble normal cells.
Page 73
digital rectal examination (DRE) – a way to diagnose prostate
abnormalities: the doctor puts a gloved finger into your rectum and feels the
prostate through the rectum wall.
genes – the template or pattern that governs the way the body’s cells grow
and behave. Each person has a set of many thousands of genes inherited
from both parents. Genes are found in most cells of the body (red blood cells
do not have genes).
Gleason score – a system for grading prostate cancer tumours according to
size and appearance.
grading – refers to the differentiation of cancer cells when examined under
the microscope.
impotence – inability to have an erection.
lymphatic system/lymph nodes/lymph vessels – The lymphatic system is a
network of very thin lymph vessels which connects the major lymph glands in
the abdomen, pelvis, groin, neck and armpits.
The lymphatic system drains away fluid waste products and damaged cells,
and contains cells that fight infection.
malignant – a tumour that is cancerous and will spread if it is not treated.
metastasis – when cancer has spread from the original site to another part of
the body. It can also be called secondary cancer.
neo-adjuvant treatment – a treatment that is done before the main treatment
to enhance the other treatment.
Page 74
orchidectomy/orchiectomy – surgical removal of the testes (testicles).
prostate-specific antigen (PSA) – a protein normally produced by prostate
cells. Tests of PSA levels are used in the diagnoses and monitoring of
prostate cancer. This involves a simple blood test.
prostatitis – an inflammation of the prostate.
radiation treatment – the use of particular forms of radiation, usually X-rays
or gamma rays, to kill cancer cells.
radical prostatectomy – the surgical removal of the prostate gland.
rectum – the last 12–15 cm of the large bowel leading to the outside of the
body.
testes (testicles) – two egg-shaped glands that produce semen and sex
hormones.
testosterone – a male sex hormone produced by the testes which stimulates
male sexual activity and the growth of other sex organs including the prostate.
transrectal ultrasound (TRUS) – an ultrasound probe is inserted into the
rectum so that ultrasound scans of the prostate can be made.
transurethral resection of the prostate (TURP) – surgery through the
urethra to remove blockages in the urinary tract.
Page 75
tumour – a new or abnormal growth of tissue in or on the body, which may be
benign or malignant.
urethra – a tube that carries urine from the bladder and semen from the sex
glands to the outside of the body via the penis.
urinary catheter – an artificial tube inserted to drain urine from the bladder
into a collecting bag.
urinary incontinence – loss of bladder control, or urinary leaking.
Page 76
Questions you may wish to ask
The following list has questions you may want to ask your cancer doctor at
appointments. We suggest you work out which questions are most important
for you to get answers to.
It’s easy to forget the questions you want to ask when you see your cancer
doctor or nurse, so write them down as you think of them and take your list
with you to your appointment:
1. What type of cancer do I have?
2. How extensive is my cancer? What stage is it?
3. What treatment do you advise for my cancer and why?
4. Are there other treatment choices for me?
5. What are the risks and possible side effects of each treatment?
6. How long will the treatment take? Will I have to stay in hospital?
7. If I need further treatment, what will it be like and when will it begin?
8. How much will it cost if I decide to be treated privately?
9. How frequent will my check-ups be and what will they involve?
10. Will I be able to continue working? If not, when will I be able to return to
work?
Page 77
11. When can I drive again?
12. Will the treatment affect my sexual relationships?
13. Will the treatment affect my fertility?
14. Will I be affected by incontinence?
15. If I choose not to have treatment either now or in the future, what services
are available to help me?
16. Are there any problems I should watch out for?
17. I would like to have a second opinion. Can you refer me to someone else?
18. Is my cancer hereditary?
19. What is the chance that the cancer can come back after the treatment(s)
offered?
20. What can I do for myself to improve my outcome?
If there are answers you do not understand, feel comfortable to say:

"Can you explain that again?"

"I am not sure what you mean by …"

"Would you draw a diagram, or write it down?"
Pagea 78 - 80
Notes
You may wish to use this space to write down any questions for, or advice
given by, your cancer doctors, nurses or health providers at your next
appointment.
Page 81
Cancer Society of New Zealand Inc.
National Office
PO Box 12700, Wellington 6144
Telephone: (04) 494-7270
Auckland Division
PO Box 1724, Auckland 1140
Telephone: (09) 308-0160
Covering: Northland
Waikato/Bay of Plenty Division
PO Box 134, Hamilton 3240
Telephone: (07) 838-2027
Covering: Tauranga, Rotorua, Taupo, Thames and Waikato
Central Districts Division
PO Box 5096, Palmerston North 4441
Telephone: (06) 356-5355
Covering: Taranaki, Wanganui, Manawatu, Hawke"s Bay and Gisborne/East
Coast
Wellington Division
52 Riddiford Street, Wellington 6021
Telephone: (04) 389-8421
Covering: Marlborough, Nelson, Wairarapa and Wellington
Page 82
Canterbury/West Coast Division
PO Box 13450, Christchurch 8141
Telephone: (03) 379-5835
Covering: South Canterbury, West Coast and Ashburton
Otago/Southland Division
PO Box 6258, Dunedin 9059
Telephone: (03) 477-7447
Covering: Urban and rural Otago and Southland
Cancer Information Service
0800 CANCER (226 237)
www.cancernz.org.nz
Page 83
Feedback
Prostate Cancer/Matepukupuku Repeure
We would like to read what you thought of this booklet, whether you found it
helpful or not. If you would like to give us your feedback, please fill out this
questionnaire, cut it out and send it to the Information Manager at the address
at the bottom of the following page.
Transcriber's Note: where tick boxes are given in this form there
will be the text "Tick Box". Where space is left for you to fill out a
comment there will be the text "Enter Text". End of Note.
1. Did you find this booklet helpful?
Yes Tick Box
No Tick Box
Please give reason(s) for your answer. Enter Text
2. Did you find the booklet easy to understand?
Yes Tick Box
No Tick Box
Please give reason(s) for your answer. Enter Text
3. Did you have any questions not answered in the booklet?
Yes Tick Box
No Tick Box
If yes, what were they? Enter Text
Page 84
4. What did you like the most about the booklet? Enter Text
5. What did you like the least about the booklet? Enter Text
6. Any other comments? Enter Text
Personal information (optional)
Are you a person with cancer, or a friend/relative/whanau? Enter Text
Gender:
Female Tick Box
Male Tick Box
Age Enter Text
Ethnicity (please specify): Enter Text
Thank you for helping us review this booklet. The Editorial Team will record
your feedback when it arrives, and consider it when this booklet is reviewed
for its next edition.
Please return to: The Information Manager, Cancer Society of New Zealand,
PO Box 12700, Wellington.
Page 85
Information, support, and research
The Cancer Society of New Zealand offers information and support services
to people with cancer and their families. Printed materials are available on
specific cancers and treatments. Information for living with cancer is also
available.
The Cancer Society is a major funder of cancer research in New Zealand. The
aim of research is to determine the causes, prevention, and effective methods
of treating various types of cancer.
The Society also undertakes health promotion through programmes such as
those encouraging SunSmart behaviour, healthy eating, physical activity, and
discouraging smoking.
Acknowledgements
The Cancer Society would like to thank for their reviews, advice, and
contributions:
Professor John Nacey
Oncologist, Department of Surgery and Anaesthesia, University of Otago,
Wellington
Professor Brett Delahunt
Pathologist, Department of Pathology and Molecular Medicine, Wellington
School of Medicine and Health Sciences, Wellington
Professor David Lamb
Oncologist, Blood and Cancer Centre, Wellington Hospital, Wellington
Associate Professor Chris Atkinson
Oncologist, St George Hospital, Christchurch and the Medical Director of the
Cancer Society of New Zealand
Dr Brendan Luey
Medical Oncologist, Blood and Cancer Centre, Wellington Hospital,
Wellington
Mr Rod Studd
Urologist, Wellington Hospital, Wellington
Bob Hale
Clinical Nurse Specialist, Urology, Wellington Hospital, Wellington
Linda Christian
Cancer Society Liaison Nurse, Northland, Auckland
Meg Biggs, Julie Holt, and Michelle Gundersen-Reid
Cancer Society Information Nurses
Sarah Stacy-Baynes
Information Manager
Some of the material in this booklet is based on information published by the
Cancer Council Victoria (Australia). The Cancer Society of New Zealand
acknowledges their assistance.
The Society thanks the people who have experienced cancer and reviewed
this edition, and offered many valuable suggestions. We also thanks the
Cancer Society volunteers who agreed to be photographed for our booklet.
Photography
The Cancer Society would like to thank Louise Goossens and Lindsay Keats
for their photography.
Cancer affects New Zealanders from all walks of life, and all regions of our
beautiful country. Cover photo: The cover booklet features a photograph
reproduced with kind permission from Brian Robinson. The photo is titled 'Old
farm shed', Matakitaki Valley, Murchison, Tasman, New Zealand.
Back Cover
Cancer Society – Te Kāhui Matepukupuku o Aotearoa
www.cancernz.org.nz
Any Question, Any Cancer
0800 CANCER (226 237) Cancer Information Helpline
End of Prostate Cancer – A guide for men with prostate cancer